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period over which patients will be followed and studied, etc.). 31 Initially pro-
posed for systematic reviews of evidence, these models apply equally to ques-
tions raised in original research studies and to questions in practice.
Meaningful practical and research questions include several of the
above-mentioned considerations in the form of acronyms and anagrams like
PICO (population, intervention, controls, outcomes) and PCICOST (popula-
tion, condition of interest, intervention, control(s), outcome(s), setting, time
frame) questions. We may ask the following:
1. Is this antithrombotic treatment good for you? Ask your doctor! This is a
kind of question used in television advertising to reach the largest audi-
ence. Let us leave it there and not use it.
2. Does antithrombotic treatment do well for patients? The least specific
and most general question. A PI question.
3. In patients surviving myocardial infarction (P), does antithrombotic
therapy (I) decrease the risk of myocardial reinfarction and death (O)?
A PICO question.
4. In patients discharged from our hospital (P) after myocardial infarction
(C), does antithrombotic therapy (I) in comparison to similar patients who
do not receive it (C) improve survival and prevent reinfarction and stroke
(O) when such a program is implemented in our hospital and regional
clinics (S) over a period of 1, 5, and 10 years (T)? A PCICOST question.
Components of research questions vary with the nature of the problem
and clinical considerations and circumstances. The third question is the most
“scientific,” specifying as much as possible to what and to whom it applies.
Let us also note that this more concrete kind of question is most often used
for the study of cause-effect relationships. Questions about the validity of
diagnostic tests, about disease occurrence (descriptive) studies, and else-
where should contain all relevant components (PICO or more) in various
combinations of the above.
Objectives are points to be reached in practical clinical problem solving
or in research, either specific to the problem or general , encompassing a
broader context into which the problem belongs. For example, we wish to
evaluate the effectiveness of vein stenting (or “liberation”) to alleviate symp-
toms of patients suffering from multiple sclerosis (a specific objective of a
defined activity) and contribute this way to the control of the severity of
cases of multiple sclerosis (a general objective for the problem of multiple
sclerosis as a whole).
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